Individual
MARK STEVEN BROCCARDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
3430 HARRISON BLVD, OGDEN, UT 84403-1231
(801) 399-5609
(801) 627-1808
Mailing address
3430 HARRISON BLVD, OGDEN, UT 84403-1231
(801) 399-5609
(801) 627-1808
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
8703927-4202
UT
Other
Enumeration date
10/04/2021
Last updated
10/04/2021
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